Why National Health Infrastructures Must Embrace Neutral Public Goods

Proprietary data silos create systemic friction. Each hospital, insurer, and lab builds isolated systems, making patient data sharing a manual, costly process. This is the equivalent of every DeFi protocol running its own incompatible blockchain.

Neutral public infrastructure unlocks network effects. A shared, open data layer, akin to Ethereum or IPFS, allows any compliant application—from research tools to AI diagnostics—to plug in and interoperate without permission.

The evidence is economic. Closed systems face quadratic scaling costs with each new participant. Open systems, like the internet's TCP/IP, scale linearly. The VA's legacy VistA system demonstrates the dead-end of a walled-garden approach.

Proprietary systems create data silos. Vendor-locked platforms like Epic or Cerner enforce incompatible formats, making patient data sharing a manual, insecure process. This mirrors the pre-DeFi era of walled-garden finance.

Neutrality enables network effects. A public data layer, akin to Ethereum's base layer or the IBC protocol, provides a common standard. Applications from any vendor can then interoperate, creating a compounding ecosystem of services.

The counter-intuitive insight is that control must be relinquished to gain utility. A national health authority does not build the internet; it mandates TCP/IP. The value accrues to the applications and users on top, not the protocol itself.

Evidence: Estonia's X-Road. This decentralized data exchange layer connects over 3,000 public and private services. It proves a neutral technical standard, not a centralized database, is the scalable model for national interoperability.

Neutral infrastructure is non-negotiable. Proprietary data silos from Epic or Cerner create vendor lock-in, making data portability and system interoperability a costly, multi-year project. A public good model, akin to the Ethereum Virtual Machine (EVM), establishes a common execution layer that any application can trustlessly build upon.

The network effect flips from vendor to ecosystem. Closed systems capture value for a single corporation. An open, permissionless data layer like a health-specific Celestia or EigenDA allows hospitals, insurers, and researchers to compose services, creating combinatorial innovation that outpaces any single vendor's roadmap.

Evidence: The HL7 FHIR standard demonstrates the demand for interoperability, but as a specification, it lacks a native settlement layer. A blockchain-based public good provides the missing cryptographic provenance and access control, turning FHIR's ambition into a live, auditable network.

APIs solve communication, not consensus. A better API cannot resolve disputes over a single, authoritative patient record when multiple private entities control the data. Blockchain's immutable ledger provides the shared source of truth that APIs query.

Private APIs create walled gardens. Epic Systems and Cerner build proprietary integration layers that lock in providers and stifle innovation. A neutral public good like a health-specific chain (e.g., a HIPAA-compliant rollup) standardizes access and competition.

The cost is coordination failure. The annual $300B+ in US healthcare administrative waste stems from reconciliation between disparate systems. A shared state machine eliminates this overhead by design, making blockchain the efficient choice for the network layer.

Evidence: Estonia's KSI Blockchain secures over 1 million patient health records, not by storing the data, but by providing an immutable audit trail for access logs across all healthcare providers, a feat impossible with APIs alone.

Procurement must target protocols, not products. Vendor-specific software creates siloed data and vendor lock-in. A protocol-first approach mandates purchasing against open specifications like FHIR or IETF standards, enabling multi-vendor interoperability and competitive runtime services.

Neutral infrastructure prevents regulatory capture. Current systems empower centralized vendors. Public goods like Ethereum's base layer or IPFS for data storage demonstrate how neutral technical layers separate governance from execution, preventing any single entity from controlling critical national infrastructure.

Composability unlocks exponential innovation. Monolithic EHR systems stifle development. Adopting a modular stack—similar to blockchain's L2/L3 model—allows independent teams to build specialized applications (e.g., credentialing, claims processing) on a shared, verifiable data layer, accelerating iteration.

Evidence: The VA's legacy VistA system, while outdated, demonstrated the power of open-source in healthcare. Modern protocol networks like Hedera for supply chain or Polygon's zkEVM for data integrity provide the blueprint for scalable, audit-ready public infrastructure.